Sleepless in the small hours

You can't beat a good night's sleep - you'll feel much better in the morning. How many times have you heard that? Sleep is highly valued in our society. We spend a third of our lives doing it, after all. But for some people the mere thought of sleep is a nightmare.

They spend hours in bed tossing and turning, unable to switch off. They go into work the next morning ratty and below par. The following night they worry whether they will get to sleep at all. Invariably, they become so worked up, they lie there once more, wide awake. So the cycle goes on, sometimes leading to a course of sleeping tablets. But then the drugs gradually lose their effect. What next?

A new clinic offering a drug-free answer for insomniacs has just opened near Ayr in Scotland, funded by the Scottish Office and a local health board, as part of a two-year research project. Health visitors have been trained to offer a psychological approach rather than a chemical one, tackling the patient's behaviour before they go to bed and offering hints on what to do rather than lie there all night wide awake.

Colin Espie is head of clinical psychology at Glasgow University, which is leading research into the clinic's effectiveness. Although the methods have been known to specialists for some time, he says, few people had access to these professionals.

"They just weren't getting the benefit of any of these techniques," he says. So, with pounds 110,000 from the Government's Novel Services Scheme - money to develop new treatments that could be of wider benefit - and Ayrshire and Arran health board, he set up the team of three part-time health visitors and one full-timer to run a weekly sleep clinic at Maybole health centre.

"One in 15 of the population will have difficulty with insomnia - either difficulty of falling asleep, or remaining asleep," says Professor Espie. "They go to bed anxious, expecting to be in for an unpleasant time or a restless night."

Most of us fall asleep naturally, without even thinking about it. An adult sleeps around seven and a half to eight hours on average, with that time reducing from the age of 50 onwards.

Although many insomniacs just put up with sleepless nights, those that do consult their doctor find there is rarely an easy answer. "The GP's main armoury is the prescription pad," says Professor Espie. His method, on the other hand, puts the patient back in control, offering them an approach that should allow them to get to sleep of their own accord. So how does he do it?

Scientists don't quite know what makes us fall asleep, but they do know we need to close down our brain-stem functions - those parts of the brain that deal with alertness and our fight or flight reactions. There also needs to be a chemical change in the brain to induce sleep. But our cognitive behaviour - in other words, our thought processes - and our behaviour can play a key part in this. This approach tackles both elements.

"Most people complain of difficulty switching their minds off," says Espie. "We are enabling people to do that. It's to do with trying to reduce the chances that thoughts are going to interfere during the night."

He admits that some people who do have real worries may need more help to sort them out. "But doing it in the middle of the night is not the time. There is no one else to balance things out. Time seems to drag. The message would be sort it out rationally in waking time, and if you need help, seek it."

Others may just get hung on not being able to sleep, per se. They think they will be a disaster at work, that people will notice, that they won't be up to their jobs; they feel a failure, frustrated and out of control.

Carole Sedgwick has had insomnia for 12 years. She had to give up her job working as a civilian with the Metropolitan Police because of her poor sleep patterns. "It's had a drastic effect on my life," she says. "Sometimes I might get a very light sleep of six hours, but it doesn't do very much. You get up feeling just as exhausted the next day. Some nights I won't sleep at all. And sometimes I just don't know how to walk.

"You name it, I've tried it - from relaxing before I go to sleep to meditation, which I found pretty good. But it hasn't cured it."

She has been to a sleep laboratory, where they wired her up and monitored her sleep pattern, but still couldn't find an answer. She has yet to use Professor Espie's methods, because she hasn't found anyone who teaches them in London, where she lives. "But I would definitely try it. I'd be silly not to. If there was some way I could get it locally, I would give it a go."

How to enter the Land of Nod

Don't go to bed until you feel tired.

Don't read or watch TV in the bedroom. Make it a place associated with sleeping.

Get up if you find yourself lying awake for more than 20 minutes. The bedroom should not be associated with restlessness.

Don't try to sleep for more hours than you need. Record your sleep pattern over a 10-night period, then calculate the average and aim for that, but build up by 15 minutes a week.

Wind down around 7pm by taking time to review the day and plan the next one.

Stop working 90 minutes before you go to bed.

Clear your mind by repeating the word "the" every three seconds.

Try to imagine yourself in a relaxing place, such as a warm, sunny beach.